Effects of Mezieres Method on Muscle Imbalance, Body Awareness and Postural Alignment in Athletes With Lower Back Pain. (MEZ-LBP)

The current study is a randomized controlled trial aims to compare the effectiveness of the Mezieres Method combined with core stabilization versus routine physiotherapy involving core stabilization on muscle imbalance, body awareness, and postural alignment in athletes with lower back pain. Eligible participants will be randomly allocated into two groups: an experimental group receiving the Mezieres Method plus core stabilization exercises and a control group receiving routine physiotherapy treatment involving core stabilization alone. Outcomes related to muscle imbalance, body awareness, postural alignment, and pain/function will be assessed before and after the intervention period. The study seeks to determine whether the Mezieres Method combined with core stabilization provides additional benefits in athletes with lower back pain.

Study Overview

• Status: Completed
• Conditions: Low Back Pain
• Intervention / Treatment: Other: Mezieres method plus core stabilization; Other: Routine physiotherapy (core stabilization)

Detailed Description

Low back pain (LBP) is the type of musculoskeletal problems affecting athletes in many sports, and it is approximately about 80% of them experience at least one episode during their career and many of them later develops long duration or recurrent pain that definitely impact performance, training routine and also day-today quality of life . Lower back pain is one of the most common musculoskeletal conditions worldwide, particularly among athletes because of repetitive strain, poor biomechanics, and muscle imbalances. In the world wide, studies estimate that nearly 60-80% of individuals experience low back pain at some point in their lives, with a point prevalence of about 7-12% in the total population and even higher rates reported in athletic populations due to intensive physical demands. In sports communities, the prevalence can range from 20% to 50%, depending on the type of sport, training intensity, and postural habits. Locally, in countries like Pakistan, the burden of low back pain is also significantly high, although underreported; hospital-based and regional studies suggest prevalence rates ranging from 30% to 70% among adults, with athletes and physically active individuals being at increased risk due to inadequate conditioning, poor posture, and lack of body awareness. These rising trends focused the importance of effective rehabilitation approaches such as the Mezieres method, which mostly focuses on correcting muscle imbalance, improving body awareness, and restore the good postural alignment. In early morning many athletes often complain more stiffness and they are type of more predisposed to LBP because of routine mechanical loading, postural strains, asymmetric movements and high demands on spinal flexibility and strength. Sports like gymnastics, soccer and dance place unusual stress on the lumbar region through repeated hyperextension, twisting and high-impact movements, which sort of increase the risk even more. These biomechanical stresses can lead to muscle imbalance, postural changes and sometimes impaired neuromuscular control, and all of this basically keep the pain going with functional limitation. The pathophysiology of LBP in athletes sometimes includes multifactorial origins including poor lumbopelvic stability, weak core muscles and asymmetrical tension in posterior muscular chains. This muscular imbalance can disrupt spinal alignment and even change the proprioceptive control so athletes start using compensatory movement patterns and recurrent injury kind of occurred again. Traditional physical therapy usually emphasis on strengthening the core, better flexibility and decrease pain with therapeutic exercises and manual therapy. Core stabilization exercises in especially have shown good efficacy on patients in improving spinal stability, posture and reducing LBP intensity. So the present study is purpose to compare effects of Mezieres Method combined with core stabilization exercises to routine physiotherapy (core stabilization exercises alone) on muscle imbalance, body awareness and postural alignment in athletes with lower back pain. And by doing so it seeks to determine whether integration of global postural re-education offers additional benefits over conventional therapeutic practices and whether difference between groups is clinically meaningful for athletes who receive these treatments.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Green International University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosed with non-specific LBP lasting at least three months with following test (Straight Leg Raise Test, Slump Test, Schober's Test )
• Athletes aged 18-35 years of either gender
• Athletes should exhibit signs of postural imbalance or muscular chain dysfunction
• Functional limitation related to posture or movement.
• Patient undergoing physiotherapy intervention for musculoskeletal disorders.
• Reduced trunk mobility, impaired postural alignment, or functional defects.

Exclusion Criteria:

• History of spinal surgery, fracture, or structural deformity (e.g., scoliosis, spondylolisthesis).
• Neurological or systemic disorders affecting balance or muscle control
• Current use of medications that may effect musculoskeletal performance (e.g., corticosteroids, muscle relaxants)
• Pregnancy or any contraindication to physical activity

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mezieres method plus core stabilization; Participants in this arm will receive the Mezieres Method combined with core stabilization exercises. The intervention will focus on global postural stretching, correction of muscle chain imbalance, breathing control, body awareness training, and activation of deep core muscles to improve postural alignment and functional outcomes in athletes with lower back pain. Treatment sessions will be supervised by a physiotherapist and conducted according to the study protocol throughout the intervention period.	Other: Mezieres method plus core stabilization; Participants in Group A was receive Mezières method therapy, focusing on progressive stretching and postural correction aimed at restoring muscle balance and improving awareness of body alignment. Sessions was target major posterior chain muscles, including the erector spinae, hamstrings, and gluteal muscles, using slow, sustained stretching techniques. Each Mezières session was last 30-35 minutes, followed by core stabilization exercises for 15-20 minutes, including plank variations, bridging exercises, and abdominal hollowing techniques to enhance trunk stability. Interventions was administered 3 times per week for 6 weeks by a trained physiotherapist.; Other Names: Group A intervention
Active Comparator: Routine physiotherapy (core stabilization); Participants in this arm will receive routine physiotherapy management consisting of conventional core stabilization exercises, lumbar strengthening, stretching exercises, and standard physiotherapy rehabilitation techniques commonly used for lower back pain in athletes. Sessions will be conducted with the same treatment frequency and duration as the experimental group.	Other: Routine physiotherapy (core stabilization); Participants in Group B was perform the same core stabilization exercises as Group A, without Mezières intervention. Exercises was target deep abdominal muscles, multifidus, and pelvic stabilizers, purpose is to improve trunk stability and support postural alignment. Each session was last 20-25 minutes, conducted 3 times per week for 6 weeks, under supervision to ensure correct technique and progression.; Other Names: Group B intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle Imbalance	Muscle imbalance refers to unequal strength or flexibility between opposing lumbar pelvic muscle groups. Muscle imbalance will be assessed using the NYPRC postural alignment and muscle imbalance assessment protocol. The NYPRC evaluates postural deviations and muscle imbalance patterns through observational assessment of body alignment in standing posture. Scores are assigned to different body segments, with lower scores indicating greater postural deviation and muscle imbalance and higher scores indicating better alignment.	Baseline and after six weeks
Postural Alignment	Postural alignment refers to the biomechanical positioning of the spine and pelvis across sagittal, frontal, and transverse planes. The New York Posture Rating Chart (NYPRC) is used to evaluate postural alignment and stability by assessing different body segments. Interpretation: Scores are assigned based on alignment of body parts (head, shoulders, spine, pelvis, etc.) Higher total score = better posture and stability Lower score = poor posture or imbalance	Baseline and after six weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body Awareness	Body awareness describes one's conscious perception and control of body position and movement. It was measured using the validated Body Awareness Questionnaire (BAQ). Higher scores reflect better proprioceptive integration. Improvements was supported by participants' subjective reports of enhanced comfort, control, and movement confidence during functional tasks.	Baseline and after six weeks
Pain Intensity	Pain intensity represents the participant's subjective level of lower back discomfort. It was evaluated using the VAS, ranging from 0 to 10. A clinically meaningful change is defined as a reduction of two or more points, as supported by previous athletic rehabilitation trials.	Baseline and after six weeks

Collaborators and Investigators

• Sponsor: Green International University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2025
• Primary Completion (Actual): March 5, 2026
• Study Completion (Actual): May 10, 2026

Study Registration Dates

• First Submitted: May 14, 2026
• First Submitted That Met QC Criteria: May 20, 2026
• First Posted (Actual): May 28, 2026

Study Record Updates

• Last Update Posted (Actual): May 28, 2026
• Last Update Submitted That Met QC Criteria: May 20, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Low back pain; athletes; Body awareness; Muscle imbalance; Postural alignment; Mezieres
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Back Pain; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Low Back Pain
• Other Study ID Numbers: GIU/REC/26-26

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be publicly shared to maintain participant confidentiality and privacy. The study data are intended for academic and research purposes only and are subject to institutional ethical guidelines and consent limitations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No